Interdisciplinary approach for neonatal emergencies

Summary

Team work of paramedics, nurse practitioners, and neonatologists in the neonatal emergency transport service

In the neonatal emergency transport service (NETS), effective coordination between paramedics, highly specialized neonatal intensive care unit (NICU) nurses or nurse practitioners (NP), and neonatal emergency doctors (NETS-MD) is essential. The NETS-MD – especially in the first weeks in service – is well advised to take advantage of the experience of paramedics and NP, particularly in terms of transport logistics. That said, the NETS-MD, preferably with a minimum of 12 months of NICU experience, should lead the initial care/neonatal resuscitation and subsequent transport (i.e., runs code and transport). Depending on their experience level, two paramedics or one experienced NICU nurse or NP may go with the NETS-MD to the emergency site, in order to perform initial care/neonatal resuscitation. This particularly applies to emergent deliveries of extremely premature or sick infants, or preterm twins (32 + 0/7 till 35 + 0/7 weeks' gestation), who need simultaneous initial care (see Table 1.1).

•In uncomplicated cases, the common goal is for active initial care (including neonatal resuscitation) to be provided by the least experienced paramedic, RN, NP or doctor under the supervision of highly qualified and experienced health care providers. Nobody gets better just by watching, and there is no learning by osmosis.

•If problems occur at the emergency site, e.g., after a cesarean (c-section) section of twins, the NETS-MD should either call the anesthesiologist on service for help, or, if available, additional neonatal or pediatric emergency transport services.